title: [The importance of upper limb diseases in occupational medicine].
abstract: OBJECTIVE
  In this work the authors analyse the results of the clinical evaluation of patients affected by suspected work related musculo-skeletal disorders (WMSDs), observed throughout 2008-2009 in the specific ambulatory of Occupational Medicine Division of Ospedali Riuaniti di Bergamo. The aim is to illustrate the epidemiological relevance of upper limb (UL) WMSDs.
  
  
  METHODS
  We observed 430 patients (mean age 46,9 years, DS 9,3; mean working seniority 29 years, DS 10,4), investigating 600 disorders in diferent musculoskeletal segments. Most of the patients (66%) got to the division for a clinical consultation requested by general practitioners, 29,8% by occupational physicians, 4,2% by national insurance for occupational injuries and diseases (INAIL).
  
  
  RESULTS
  Most of the patients (38,4%) were employed in construction industry. Among the 600 disorders investigated, 34,5% was at lumbar spine, 74,5% was at upper limb. The clinical diagnosis was already clear at the first consultation for 81,6% of subjects with low back pain and for 56,5% of patients with upper limb disorders; for the others was necessary to prescribe some instrumental exams or specialistic (neurologic, physiatric, orthopaedic) medical examination. We concluded for a diagnosis of WMSDs in 48,3% of the 600 cases: the percentage is 50,2% if we consider only disorders at lumbar spine and 52,5% among disorders at upper limb. The most frequent reason of refusing occupational aetiology, in the cases of low back pain, was the concomitant presence of other diseases at the segment; on the contrary, for the cases of upper limb disorders, was the lack of correlation between type of disease and professional exposure.
  
  
  CONCLUSIONS
  All physicians demonstrate a high attention about upper limb disorders, topical subject of great epidemiological interest. General practitioners and occupational physicians have to take more advantage of diagnostic support and clinical evaluations offered by Occupational Medicine Divisions an Universities about WMSDs. In consideration of the dificulties to diagnose upper limb disorders and proving correlation with professional exposure is useful to promote specific courses for general practitioners and occupational physicians.
authors.affiliation: Unità Operativa Ospedaliera Medicina del Lavoro - Azienda Ospedaliera Papa Giovanni XXIII, Bergamo. mriva@hpg23.it
authors.forename: Matteo Marco
authors.initials: MM
authors.lastname: Riva
authors.forename: Marisa
authors.initials: M
authors.lastname: Santini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mosconi
mesh_terms: D060389:Construction Industry / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D017116:Low Back Pain / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D009784:Occupational Diseases / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D009787:Occupational Medicine; D010045:Outpatients / Q000706:statistics & numerical data*; D034941:Upper Extremity